High contamination rates of shoes of veterinarians, veterinary support staff and veterinary students with Clostridioides difficile spores

Abstract

Clostridioides difficile is often found in animals and their environment. However, not much has been reported on veterinary clinics environment in terms of the spore load, prevalence and PCR ribotype diversity. The aim of this study was to assess the prevalence of C. difficile on shoe soles of veterinarians, veterinary support staff and veterinary students at the Veterinary Faculty campus. Altogether, 50 shoe sole swabs were collected, and the positivity rates ranged from 86.7% in swabs from veterinarians to 100% in swabs from support staff and students. Non‐toxigenic and toxigenic strains representing toxinotypes 0, IV and XIX were isolated and distributed into 17 different PCR ribotypes, most common being 010, 014/020, SLO002 and 009. PCR ribotype 010 was the most prevalent and isolated from shoe soles sampled in 6/7 areas. Students' shoes had highest ribotype diversity (15/17 PCR ribotypes) but showed a low overlap with ribotype isolated from vets and support staff shoes. Veterinary students are likely the main vectors of C. difficile spores transmissions among veterinary teaching clinics and the hospital.

Whole-genome sequencing links Clostridium (Clostridioides) difficile in a single hospital to diverse environmental sources in the community

“…In contrast to our study where the floor isolates were dominated by RT 010 (96.6%), the most common strain identified in their study was ST 42 (likely RT 106) which represented 21.4% of their isolates (Srinivasa et al, 2019). Meanwhile, the reported prevalence of C. difficile on shoe soles collected from households ranges from 11.7% in Bangladesh to 43% in Slovenia both of which are much less than the >86.7% from the shoes of veterinary staff and students in Poland (Islam et al, 2019; Janezic et al, 2018; Wojtacka et al, 2021). While RT 010 comprised up to 73.2% of our shoe isolates, other studies reported a greater diversity of RTs with their most common RT only comprising 20%, 24%, 36% and 40%–50% of the isolates in the United States, Poland, Bangladesh and Slovenia respectively (Alam et al, 2014; Islam et al, 2019; Janezic et al, 2018; Wojtacka et al, 2021).…”

“…However, C. difficile causing infection is more likely to have originated from animals and/or the environment, suggesting this is a “One Health” problem. There are many possible routes of C. difficile transmission from the community into hospitals, including via food (Lim et al, 2018), shoe soles (Wojtacka et al, 2021), support animals (Lefebvre et al, 2006) and colonized individuals including hospital patients (Zacharioudakis et al, 2015) and staff (Friedman et al, 2013). This study investigated if C. difficile is being imported into the hospital setting from the community via contaminated shoe soles, and if clinical CDI cases could be genomically linked to hospital and/or community environmental sources.…”